BPP-11-1391 (2)4
Miami Shores Villages
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No.
30EIIVIE
AUG 0 4 2011
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): iley6 P0 LA N.G d Phone#: ? M
Address: (ITS N e 411 Sk rt'a r ra- ck
City: A40" l 511 V' State: f'tr Z'ip: 3 1 S
Tenant/Lessee Name: Phone#:
Email: ej/Se M eate~ec. 01.0 e'.. 0 0,
JOB ADDRESS: l l e 3 N E co
City: Miami Shores County:
Folio/Parcel #: 11 24> Ig%.0 01 0 0 0
Is the Building Historically Designated: Yes
Miami Dade
Zip: 3 3 t3 8"
Flood Zone:
CONTRACTOR: Company Name: raltrn t I�.
Address: 1+59-0 � 114/- ;A V
City: State:
Qualifier Name:
State Certification or R gistration #: ° ` fi r Certifi
Contact Phone#: Z.5. t ' IQ Email Address:
Phone#: I'6R.I` fi 9(,IJ�J
Zip:f 55
Phone#:
. o Competency #:
t " P L rYiAl s goat
DESIGNER: Archifect/Engvneer: v Phone#:
Value of Work for this Permit: $ 4WD.
Type of Work: ❑Address ❑A1te lion
Description of Work: 9.ai
e/Linear Footage of Work:
❑Repair/Repl
* * *** ** * *** * * **************** ***w*** *** Fees*******+►**** ** ***** x. **********+x+x•x****** ** **
Submittal Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Permit Fee $ F.0'62,'40
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Lndin Company's Name (if applicable
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for FT.ECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the forego ;; oatroh re a
applicable laws regulating construction and zoning.
be done in compliance with all
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estima
promise in good faith that a copy of the notice of commencement and construction lien
whose property is subject to attachment. Also, a certified copy of the recorded notice of co
for the first inspection which occurs seven (7) days after the building permit is issued
inspection will not be approved and a reinspection fee will be charged.
Signature1/
Owner. r.Agent
The fore_oing instrument was acknowledged b,ef
day of J... ,20,jam,,by,b"c,'
who is personally .+t own to me or who its produced
value exceeding $2500, the applicant must
rochure ill be delivered to the person
eme t must be posted at the job site
ence of such posted notice, the
Signs
tor
e foregoing instrument was ackno ' ledged before me this
o ` i • b . , I I " . , 20 11, by
who is perso y known to me or who has produced
Licort as identification and who did take an oath.
G 4.11)62' , day
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
APPROVED BY
NOTARY PUBLIC„.
Sign:
Print.
My C
7.rett7- 7-74A
M Comm. Expires Sep 12, 2014
'c
�.;• Commission N
x1#5ffid Throes National Wary Assn.
sor
I 6t Plans Examiner Zoning
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk